Cutaneous Tuberculosis in a 22-Day-Old Neonate:A Diagnostic Challenge and Case Report

Cutaneous tuberculosis (CTB) is a rare extrapulmonary manifestation of tuberculosis, particularly in neonates. Its diagnosis is often challenging due to non-specific presentations that can mimic common conditions.

We report the case of a 22-day-old male neonate who presented to the emergency room with fever and a scalp swelling following a reported fall from bed. Initial assessment suggested a subcutaneous abscess. The patient did not respond to multiple courses of intravenous antibiotics. A blood culture grew Burkholderia species, but targeted therapy also failed. Incision and drainage were performed, and pus GeneXpert testing was positive for Mycobacterium tuberculosis, despite a negative tuberculin skin test and clear chest X-ray. A final diagnosis of cutaneous tuberculosis (tuberculous chancre) was established.

Anti-tuberculosis therapy (ATT) was initiated, leading to the complete resolution of the swelling and full recovery.

This case underscores the diagnostic challenges of neonatal CTB. It highlights the importance of considering tuberculosis in the differential diagnosis of non-resolving abscesses in infants, especially in endemic areas, and demonstrates the critical role of molecular diagnostics like GeneXpert in achieving a timely diagnosis.